HIVST

1-Policy uptake of WHO recommended HIV testing approaches 

Source: WHO, Unitaid, and UNAIDS meeting on HIV self-testing and innovative testing approaches in Asia and the Pacific Region: Country progress and plans, December 2020

Nepal is one of the few countries in Asia that has fully adopted 2015 WHO guidelines recommendations on HIV testing services and has a national policy on HIV self-testing since 2017. The country has also adopted the policy on HIV testing provision free to all and has a law specifying HIV testing solely performed based on voluntary and informed consent. Further, WHO 2016 key populations guidelines recommendation are fully included in national policy/plans.

Further, in Nepal, HIV testing is mandatory for surgical cases, migrants and certain drug treatment centres although it is not in policy. The coutry also has a national policy/ strategy on linking HIV testing and counselling and enrolment in care.

The Nepal HIV Strategic Plan (NHSP) 2016–2021 prioritizes HIV investments for prevention, case finding and management to achieve the 90-90-90 targets. Nepal has also adopted the ‘test and treat’ strategy and community-led testing approaches and incorporated new approaches such as community-led testing (CLT) for test-for- triage, differentiated service delivery, HIV self-testing (HIVST), pre-exposure prophylaxis (PrEP), and use of information and communications technology (ICT) in the revised National HIV Testing and Treatment Guidelines 2017. 

Nepal uses targeted HIV testing among KPs, index testing, risk network referral, the enhanced peer outreach approach (EPOA), online to off-line approach, and HIVST. A new online platform offering risk assessment and service appointment tools named MeroSathi (My Friend) has been launched to reach and test hidden and virtually active KPs . 

ARV is provided by the government and distributed from ART clinics, free of cost. The country has 175 HTC sites, 78 ART sites, and 22 ART dispensing sites. PMTCT services has now been scaled up to all 77 districts (NCASC, 2018). Access to HIV prevention messages, testing, care, and treatment services for key populations (KPs) and people living with HIV (PLHIV) has increased significantly over the years with the scale-up of HIV testing and counselling (HTC) sites and decentralization of antiretroviral therapy (ART) and prevention of mother-to-child-transmission (PMTCT) services.

2-Implementation status

Even though the policies are in place in Nepal, implementation is not underway yet. Several successful pilots have been undertaken in the country however.
LINKAGES Pilot: HIV self-testing and community-led testing for HIV minimized distance-related barriers for HIV testing

The HIV self- testing demonstration study, implemented from June to September 2018 by LINKAGES in Nepal, identified 12 (2.7 percent) of 440 participants as HIV positive. The project-initiated CLT by lay providers in August 2018. During January to June 2019, CLT identified 0.6 percent of HIV-positive individuals out of 18,403 tested for HIV. The CLT for HIV has helped lessen stigma and discrimination and motivates greater uptake of HIV services. Communities often have better trust in their peers for receiving confidential services at places convenient for them.

3-Product Registration and Costing of HIVST Kits 

HIV testing services is free  and oral fluid-based test kits are used for HIVST in Nepal. Oraquick® is currently registered in Nepal.

Oral fluid-based test kits are used for HIVST in Nepal. Oraquick® is currently being recommended by the Government of Nepal. Oral fluid-based HIVST is not recommended for people taking antiretroviral (ARV) drugs however, as this may cause a false non-reactive result.